In an era of advancing medical science, it’s imperative to recognize that peoples’ well-being is intricately woven from an array of different threads. A holistic approach to healthcare transcends the confines of isolated diagnoses, recognizing the profound interplay between mind and body. By addressing the complete spectrum of an individual’s health, we unlock a more effective and sustainable path towards true healing and flourishing.
We sat down with Suzanne Kunis, Founder, President, and CEO of NovaWell, to discuss the importance of treating people holistically, breaking down long-held mental health stigmas, and how emerging trends and technologies will facilitate the integration of physical and behavioral health in the years ahead.
Around ten months ago, you founded NovaWell. What led up to this? What problems did you set out to solve?
Around six-and-a-half years ago, I joined Horizon Blue Cross Blue Shield of New Jersey to revolutionize their behavioral health strategy. At the time, behavioral health services were outsourced to a managed behavioral health organization, and leadership said to me, “Look, the science is showing value in integrated care, but we need a strategy. Can you come in and develop a strategy for us and help us get to a better place?” My answer, of course, was, “Sure, I’d be more than happy to do that!”
When I got there, I became the organization’s first dedicated behavioral health employee, overseeing a team that eventually grew to 270 members. We honed in on New Jersey, pinpointing critical challenges: access to care, clinician availability, pervasive gaps in the system, and the fact that integration between physical health and behavioral health was not really a consideration. These issues necessitated a ground-up approach. With a small team, we envisioned an ideal behavioral health framework. We asked ourselves, “If we could start anew, how would we structure it?” This deliberation eventually led to a three-pronged strategy.
Firstly, we advocated for viewing people as people and not defining them solely by their health conditions. We promoted the idea that a person’s mental health is inseparable from their physical health. This cultural shift was vital; it meant more than just insourcing behavioral health. It involved a complete re-education of the organization, from executives to frontline staff, about the nature of behavioral health.
Secondly, we tackled the issue of access. We designed a digital platform, a “front door,” offering educational resources, podcasts, and videos. An innovative assessment tool was developed and implemented, guiding people towards appropriate care based on their responses. This system streamlined access to 18 different provider solutions, covering a spectrum of services from specialty care to general psychiatry.
Lastly, we extended our efforts beyond organizational walls. Recognizing that serious mental illness and substance use disorder patients were falling through the cracks, we focused on integrated care with community mental health providers. Although they could treat these members, we have many wonderful providers out there. The intent of this engagement was to ensure that the community mental health providers focused on ensuring that their total health was managed—physical and behavioral—and that social needs were met. Essentially, they became the member’s “quarterback” for care.
This comprehensive approach yielded some pretty impressive results. Within six months, self-reported patient data demonstrated remarkable improvements. Members reported feeling hope, improved quality of life, and fewer days of drug and alcohol use, to name a few of the key outcomes. We then extended the program statewide. Now, with claim data, we saw that total medical cost decreased by 20%, inpatient admissions dropped by 51%, and ER visits decreased by 27%.
The success of this set of solutions and a new integrated care model garnered attention from health plans nationwide, prompting the founding of NovaWell—a venture aimed at replicating this model to address the nation’s behavioral health issues on a broader scale.
In the rapidly evolving healthcare landscape, how do you see the integration of behavioral and physical health progressing in the coming years? Are there emerging trends or technologies that you find particularly promising in achieving this integration?
That’s a great question. The importance of prioritizing people’s well-being for improved outcomes and cost-effectiveness is abundantly clear. Based on our experience, community-based initiatives have exhibited greater success compared to the often compartmentalized nature of large health systems. While departments like cardiology or gastroenterology may exist within these systems, they tend to operate in relative isolation, with consultations available but mental health may not be top of mind as a consideration. That is clearly changing. Mental health and substance use are gradually gaining recognition within this framework, though progress is incremental.
In terms of emerging trends, there’s a growing consensus on the substantial value, both from a humanistic and economic standpoint, in integrating behavioral and physical health. Noteworthy models, such as the AIMs approach from the University of Washington, hold great potential, but grappling with provider adoption remains a big challenge. This suggests that there is no singular panacea; a diverse array of strategies is necessary.
Certain partnerships with provider organizations have shown promise. Initially focused on addressing mental health or substance use issues, they are progressively expanding their services to encompass physical health care as well. This expansion underscores the need for innovative approaches. For instance, community-based providers must revamp their organizational structures to facilitate more effective partnerships. Acknowledging that no one entity can cater to all needs, especially given the scarcity of specialized clinicians, alternative services like peer support are gaining prominence. Studies highlight peer support and traditional therapy’s comparable impact on specific patient groups.
The integration of technology also figures prominently. However, it’s essential to recognize that merely co-locating services is insufficient. True progress lies in comprehensive case management, overseeing the entirety of a patient’s care journey. Collaborative care, with its potential to bridge the gap between physical and behavioral health services, definitely warrants further attention, and enhancing its adoption rate is key to achieving genuine integration.
Ultimately, the evolving landscape demands a multifaceted approach, combining technological advancements, community-based partnerships, and robust case management. These endeavors collectively strive toward the overarching goal of seamless integration between behavioral and physical health services, ensuring that people receive comprehensive, holistic care.
For our readers who may not be familiar, can you explain what you mean by collaborative care?
Collaborative care was designed originally by the University of Washington, the AIMS model. There are several models out there, but stated very simply, it’s establishing an infrastructure in a primary care practice, where a psychiatric nurse or other behavioral health professional acts as a case manager for patients in need. The goal is to ensure that PCPs and their behavioral health treatment providers/partners are talking, making sure there’s a single plan of care for that member and that there is adherence to the care plan or adjustments made as needed. They will have contracted psychiatry services. So, a psychiatrist can provide guidance and counsel for medications and support the PCP in dealing with other issues presented. It’s meant to be a solution for getting everybody in one room together—virtual or not—and to be able to look at a person holistically and provide a care plan that addresses all of their needs.
You’ve emphasized the importance of treating people holistically rather than focusing solely on their conditions. Can you speak to how this patient-centric approach impacts lives?
I have a perfect example for you. In our integrated care pilot in New Jersey, a member in his thirties was grappling with opioid use disorder. He was in and out of treatment multiple times in the year prior to becoming part of this program, and had spent over a hundred thousand dollars in care. Upon enrolling in our program, he underwent an exhaustive bio-psychosocial assessment, mirroring a comprehensive primary care visit. This included a detailed medical history, behavioral health evaluation, and thorough blood work. This holistic approach revealed that there was something wrong with his thyroid.
Recognizing the seriousness of the situation, our provider partner accompanied him to a specialist, offering crucial support for someone primarily focused on overcoming addiction. The specialist revealed that he had thyroid cancer. This revelation, which can be so easily overlooked in the throes of addiction, really underscored the necessity of our integrated approach. Prompt intervention led to successful treatment, ultimately rendering him cancer-free.
But beyond identifying and treating the cancer, our program catalyzed a profound transformation in his life. He’d been estranged from his family due to years of addiction, so we facilitated their reunion. We assisted him in job training through concerted effort, empowering him with newfound skills and confidence.
A year into the program, he emerged not only in recovery and cancer-free but also gainfully employed and reconnected with his family. This success story really encapsulates the profound impact of compassionate, comprehensive care. It exemplifies the potential for true healing when people receive the right support and attention. By addressing the entirety of a person’s needs, we can effect remarkable change, not only in their health but also in their overall quality of life. This is the essence of integrated care: treating the whole person, not just the symptoms.
Mental health awareness and destigmatization have gained significant traction in recent years. What are the most critical steps society can take to further reduce the stigma surrounding mental health conditions like OCD and promote open conversations about recovery?
That was one of the huge issues we identified right up front. We were trying to say, what are all the problems here? Stigma, stigma, stigma. I think if there’s a silver lining to COVID, it was actually getting people to talk about this more openly. Kaiser Family Foundation did a study during COVID-19 revealing that approximately 40% of adults actually had a diagnosable mood disorder during the course of COVID, so it actually started getting people’s attention. We are all impacted in one way or another.
I was at the HLTH conference last year, and at a breakfast meeting with a number of different health plans and providers, I went around the table and said, “Why are you in this? What does this mean to you?” Everyone at that table, about 20 people, had a personal story, whether it was themselves, their friend, their family member, or their coworker. It’s like, I didn’t pick you to come here because you have a story—we’re just all in the same boat. Everybody knows somebody.
It may not be a forever issue. It could be a short-term issue, but we all have problems until we start talking about them, exposing ourselves, and saying it’s okay to not be okay. Tons of public service announcement work needs to be done and is getting done, but kids are my hope for the future because they’re raised to be comfortable talking about this, whereas older folks weren’t. I was recently at a party in a 55-plus community. People there knew that I was in mental health, and somebody was describing a person there who was having problems, and she goes, “[whispers] he has depression.” And I’m like, “It’s okay to say it out loud!” There is still the old cancer or AIDS stigma out there. The way we get rid of it is by talking about it—talking about it in schools, talking about it everywhere. People need to understand that, again, it’s okay not to be okay.
